title: Risk factors of hospital mortality after re-laparotomy for post-hepatectomy hemorrhage.
abstract: BACKGROUND
  Post-hepatectomy hemorrhage (PHH) requiring re-laparotomy is a life-threatening situation and is associated with a considerably high hospital mortality rate. However, risk factors of hospital mortality in patients with this condition have not yet been investigated.
  
  
  METHODS
  The perioperative data of 258 patients with hepatocellular carcinoma who underwent re-laparotomy for PHH from 1997 to 2011 were retrospectively reviewed and evaluated by univariate and multivariate analyses to identify risk factors of hospital mortality.
  
  
  RESULTS
  Hospital death occurred in 43 patients between 16 h and 40 days after re-laparotomy, and the overall mortality rate was 16.7 %. The median time lag between first recognition of active bleeding and re-laparotomy was 6 h (range 0.5-34 h). The mortality of patients undergoing late re-laparotomy (≥6 h) was much higher than those undergoing early re-laparotomy (<6 h) (25 vs 8.6 %; P = 0.001). Multivariate analysis showed early time period (1997-2004) (P = 0.040), liver cirrhosis (P = 0.025), ineffective hemostasis during re-laparotomy due to coagulopathy (P = 0.038), late re-laparotomy (≥6 h) (P = 0.032), postoperative liver failure (P = 0.001), and postoperative acute renal failure requiring hemodialysis (P = 0.024) were independent risk factors of hospital mortality.
  
  
  CONCLUSIONS
  Immediate re-laparotomy is a key factor to reduce hospital mortality for patients with active bleeding after partial hepatectomy. More care should be taken in those patients who develop acute liver failure and/or serious acute renal failure after re-laparotomy.
authors.affiliation: Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, Shanghai 200438, People's Republic of China.
authors.forename: Tian
authors.initials: T
authors.lastname: Yang
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhong
authors.forename: Wan Yee
authors.initials: WY
authors.lastname: Lau
authors.forename: Han
authors.initials: H
authors.lastname: Zhang
authors.forename: Xing
authors.initials: X
authors.lastname: Huang
authors.forename: Wei-Feng
authors.initials: WF
authors.lastname: Yu
authors.forename: Feng
authors.initials: F
authors.lastname: Shen
authors.forename: Jie-Wei
authors.initials: JW
authors.lastname: Li
authors.forename: Meng-Chao
authors.initials: MC
authors.lastname: Wu
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D017052:Hospital Mortality; D006801:Humans; D007813:Laparotomy / Q000401:mortality*; D008113:Liver Neoplasms / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019106:Postoperative Hemorrhage / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome